Your cancer stage is key to getting the best treatment. It helps predict how your treatment will work, too.
Your uterus (womb) is the medium-sized pear shaped organ where babies grow. Each month, it sheds the endometrial lining and grows it again. This happens over and over, but sometimes leads to cancer.
Endometrial cancer often begins in the uterine lining. It's also called uterine cancer. It's the most common female reproductive cancer. In fact, uterine cancer is the fourth most common cancer for women in the U.S.
Your doctor first diagnoses the type of uterine cancer. They'll look under a microscope to see what your tumor cells look like.
Most uterine cancers are endometrioid adenocarcinomas (endometrial cancer). But other types include carcinosarcoma, serous carcinoma, clear cell carcinoma, and more.
Although there are many types of uterine cancer, most are endometrial. It starts in the inner lining of your uterus.
But carcinosarcomas (uterine sarcomas) start in the muscles or surrounding uterine tissues. It's a rarer form of uterine cancer that spreads faster. The difference is very important, especially for women of color.
In fact, women of color are twice as likely to die from endometrial cancer. One reason may be because current treatments don't work as well for uterine sarcoma. And Black women have a higher risk for this faster-spreadingform of uterine cancer.
How Does Uterine (Endometrial) Cancer Staging Work?
Your cancer stage is how much and how far it spreads in your body. Your doctor will use tests to stage your tumor. This may mean surgery to remove your tumor, first.
Your doctor will also ask about your medical history and do an exam. They'll take a tissue sample, order imaging scans, and do a blood test, too.
Endometrial tissue sample
Your doctor will take an endometrial tissue sample. You'll likely get a biopsy or a dilation and curettage (D&C). If you get a D&C, your doctor can also do a hysteroscopy. It's where they insert a thin lighted tube into your uterus to look for cancer.
Imaging and other studies
Your doctor may also do imaging studies:
- Chest X-ray checks your lungs
- Computed tomography (CT) checks other organs
- Magnetic resonance imaging (MRI) checks brain, spinal cord, and lymph nodes
- Positron emission tomography (PET) checks smaller clusters of cancer cells
These tests give more information about your uterine cancer type. Your doctor can also tell if the cancer has spread. If needed, they'll do a cystoscopy to look inside your bladder. Your doctor can also do a proctoscopy to check your rectum.
Blood testing for uterine cancer
Your doctor will take a sample of your blood and run a complete blood count (CBC). They'll also test for CA-125. This cancer marker often gets made by uterine and ovarian cancer cells, but not all.
Uterine cancer staging
Doctors use two ways to stage your uterine cancer. The International Federation of Gynecology and Obstetrics (FIGO) is one way. The other is the American Joint Committee of Cancer TNM staging system. They are almost the same.
Both systems use three ways to stage: tumor size, cancer in the lymph nodes, and how far it spreads (metastasis). The TNM staging system uses letters:
Tumor (T). How big is the main tumor and is it in nearby organs?
Lymph nodes (N). Has the cancer moved into nearby lymph nodes? These small, bean-shaped glands help your immune system fight germs.
Metastasis (M). Has the cancer spread to faraway lymph nodes or other organs? This is called metastasis.
Doctors use TMN staging to put numbers after the letters T, M, and N. These numbers tell you how far along your cancer is. Once your doctor works out the staging, you'll decide on treatment.
Although doctor's use stages I to IV, this article uses the common numbers 1 to 4. With FIGO staging, the lower numbers mean your cancer hasn't spread as much.
Stage 1 Uterine Cancer
Stage 1 (T1, N0, M0) means your cancer hasn't spread past your uterus or ovaries. It's not in nearby lymph nodes (N0). Your tumor is not in other parts of your body (M0).
Within this stage are:
Stage 1A (T1a, N0, M0). It's in the inner lining of your uterus (endometrium) and ovaries. Your cancer isn't in nearby lymph nodes or other body parts. But it may be in your uterine muscle.
Stage 1B (T1b, N0, M0). Your cancer is in your uterine lining (endometrium). It's halfway through your uterine muscle, too. The tumor hasn't spread to lymph nodes or other body parts.
Stage 1C. Your cancer is in your endometrial lining. These cancers usually spread faster.
Stage 1 symptoms
You may not have symptoms at first. So regular check-ups are important for your health.
The most common symptom is bleeding that isn't normal. That can mean spotting or bleeding between your menstrual periods. You may also have watery or blood-tinged discharge from your vagina.
If you've gone through menopause, any vaginal bleeding can be a symptom. Typically, uterine cancer is diagnosed around 60 years of age. So it’s unusual to menstruate at this stage in life.
Keep in mind that not everyone has bloody discharge. Sometimes, non-bloody vaginal discharge can signal uterine cancer, too.
Always ask your doctor about any symptoms that don't seem normal. It can be hard to tell what the cause might be like infection, homonal changes, or cancer.
Stage 1 treatments
Sometimes, surgery may be the only treatment you'll need. You'll likely get a total hysterectomy. This procedure removes your uterus and cervix. Your doctor may take out your fallopian tubes and ovaries, too.
Your surgeon may also do a pelvic washing. That's when a saltwater solution flushes your abdomen. Then it's checked for cancer cells. After surgery, your doctor will watch you closely for signs of cancer.
Surgery might be enough
But if you have bigger tumors or a fast-spreading cancer, you may need more treatment. Tiny cancer cells may have spread outside your uterus.
To keep the cancer from returning, you may need radiation therapy, vaginal brachytherapy, or both. Brachytherapy delivers a radioactive rod into your vagina to kill off nearby cancer cells.
If you have a fast-spreading cancer, you may get chemotherapy after surgery. Some doctors use carboplatin and paclitaxel, but others are used, too.
Your doctor can talk to you about leaving your ovaries behind. If you're not in menopause, this can help this stage of life come on naturally. But your ovaries can also raise your chances for the cancer returning. Talk to your doctor about your specific health risks.
Cancer and fertility
You have options if you still want to get pregnant with stage 1A endometrial cancer. Talk to your doctor about using progestin therapy. If it's possible to delay surgery, you may be able to use this treatment.
These hormones can help shrink or kill cancer cells. The therapy can give you some time to become pregnant. Your doctor will watch you closely.
If there's no cancer after 6 months, you can try to get pregnant. Your doctor will continue to watch you. There's a risk the hormones won't work, and your cancer can spread. Talk to your doctor about the benefits and risks for this treatment.
Stage 2 Uterine Cancer
This stage or T2, N0, M0 means the cancer has spread from your uterus into the tissue of the cervix. You may have some lymph nodes or blood vessels affected.
If you have a fast-sreading uterine cancer, it could be in the uterine muscle. But the tumor is not in nearby lymph nodes or other body parts. This stage also includes:
Stage 2A. Your uterine cancer is in the tissue of your cervix.
Stage 2B. The cancer is in the lymph nodes or blood vessels of your uterus.
Stage 2C(T2, N0, M0). Your cancer is in the muscle layer of your uterus. These are usually fast-growing uterine sarcomas.
Stage 2 symptoms
You'll commonly get unusual bleeding, spotting, or discharge. But not seeing blood doesn't rule out cancer. If you have an unusual discharge, talk to your doctor. They can help you figure out what may be going on.
Stage 2 treatment
Most often you'll get a radical hysterectomy surgery. This surgery removes your:
Uterus
Tissues near your uterus
Cervix
Upper part of your vagina
Your surgeon may also remove your fallopian tubes, ovaries, and nearby lymph nodes. When you have a fast-spreading tumor, they'll carefully check your lymph nodes (omental biopsy or omentectomy).
Surgery doesn't always get all the tiny cancer cells in your body. So you may also need radiation therapy or vaginal brachytherapy to kill off the remaining cancer.
Sometimes you may get radiation therapy first. Then your doctor can do surgery. They'll check nearby lymph nodes, too.
And if surgery isn't an option, you'll get radiation and brachytherapy. Chemotherapy is also used. It can help prevent the cancer from returning. Cisplatin or carboplatin with paclitaxel often treat uterine cancer.
Stage 3 Uterine Cancer
The cancer has spread outside of your uterus. It can be in your ovaries, fallopian tubes, vagina, or lymph nodes nearby. But it's not in your bladder or the inner lining of your anus (rectum). Stage 3 includes:
Stage 3A (T3a, N0, M0). It's in the outer layer of your uterus. The cancer may have spread to your fallopian tubes and ovaries, too.
Stage 3B (T3b, N0, M0). This stage includes cancer spreading to the tissues around the uterus or vagina.
Stage 3C1 (T1 - T3, N1, N1mi or N1a, M0). The cancer has spread outside of the uterus. It's in your pelvic lymph nodes (N1, N1mi, N1a).
Stage 3C2 (T1 - T3, N2, N2mi or N2a, M0). Your cancer has spread to lymph nodes near the major blood vessels in your belly (para-aortic). But it isn't in other parts of your body.
Stage 3 symptoms
As the tumor grows and spreads, it can put pressure on other organs or blood vessels. With uterine cancer you may have:
- Unusual vaginal bleeding or discharge
- Pelvic or belly pain
- Bloating or feel full
- Pain during sex
- A full feeling when eating
- Changes in your bowel or bladder habits
- Weight loss without trying
- A lump or feel the tumor in your belly
Stage 3 treatment
If your doctor thinks your tumor can be taken out, they'll do a total or radical hysterectomy. Your doctor may remove your:
- Uterus
- Fallopian tubes
- Ovaries
- Nearby lymph nodes with cancer
- Cervix
- Nearby tissues with cancer
Your doctor may also do a pelvic washing. If you have stage 3A uterine cancer, after surgery you'll likely get chemotherapy, radiation, or both. You'll get radiation to your pelvis or to your belly (abdomen) and pelvis. Your doctor may also suggest vaginal brachytherapy.
If your cancer is stage 3B or 3C, your doctor may suggest chemo, radiation, or both after surgery. But if you have a faster-growing cancer type, your surgeon may look at nearby lymph nodes. They'll take out any with cancer or nearby tissues, too (omentectomy and peritoneal biopsies).
This is followed by chemotherapy, radiation, or both. Cisplatin or carboplatin and paclitaxel can help keep the cancer from coming back.
Stage 4 Uterine Cancer
The cancer is in the bladder, rectum, or organs far from the uterus, such as the lungs. Within stage 4 are:
Stage 4A (T4, Any N, M0). Your cancer has spread to the inner lining of your bladder or anus (rectum). It's possibly in nearby lymph nodes, too.
Stage 4B (Any T, Any N, M1). It's in your upper stomach (abdomen). The cancer may be in the fat supporting the lower part (called the omentum) of your belly. It may or may not be in your lymph nodes.
Stage 4C. Your cancer has spread to other body parts like the liver, lungs, or brain. It can also spread to other organs like your lungs, liver, bones, or to lymph nodes in your groin.
Stage 4 symptoms
You can get any of the symptoms of stages 1 to 3 like bloody or unusual discharge. You can have pelvic pain, bloating, or pain during sex. You may feel full quickly when eating or feel a lump in you belly. You can also get changes in your bowel habits or lose weight.
But you may also get symptoms in the areas where your cancer spreads. That can mean things like pain in your bones or shortness of breath. It depends on which organs are affected.
Stage 4 treatment
Many times, stage 4 uterine cancer has spread beyond your uterus. This can make surgery difficult. But if you're bleeding, you may still get surgery. Your surgeon may do a total or radical hysterectomy, if possible.
Treatment can depend on your cancer type and where it's at in your body. You may get radiation or hormone therapy. If you have a fast-growing tumor, hormone therapy isn't the best option. These treatments don't work on fast-spreading tumors.
Your doctor can combine chemotherapy medicines. And sometimes, they'll suggest immunotherapy or targeted therapy, too. If you're interested, talk to your doctor to see if a clinical trial is right for you. Sometimes, these trials can offer promising new treatments.
Takeaways
Although endometrial is the most common uterine cancer, the faster-growing sarcoma happens more often in Black women. Your doctor will diagnose your cancer type and stage your tumor. They'll use your cancer stage (1-4) to help you decide on the best treatment plan for your health.
Uterine (Endometrial) Cancer Stage FAQs
Can you have uterine cancer for years without knowing it?
About 1 in 5 women don't get symptoms. But many times you can bleed, cramp, or have pain. If you're younger, you may get irregular spotting. You can also lose weight or get a low red blood cell count (anemia).
What is your life expectancy if you have uterine cancer?
No one can tell you exactly how long you'll live with uterine cancer. It can depend on many factors like your age, genetics, and how well you respond to treatment. Of course it can depend on your cancer stage, too. If you have a later cancer stage at diagnosis, your life expectancy can go down.
Here are some general numbers:
- With treatment, about 81 in 100 women live about five years.
- If your cancer has spread to other organs at diagnosis, about 18 in 100 women live about five years.
But keep in mind that your overall health and how your cancer responds to treatment count, too. And as treatments improve, they can also lengthen your life expectancy.
How fast does uterine cancer grow?
It depends on the type of cancer you have. Endometrial cancer (the most common type) typically grows slowly. But the rare type called uterine sarcoma can grow quickly. It can also spread to other parts of the body.
Does stage I uterine cancer require chemo?
Chemotherapy usually isn't used for early stage I or II endometrial cancer. But if you have a faster-growing uterine sarcoma, your doctor may suggest chemo to prevent it from spreading.
So it's important to know which type of uterine cancer you have.
What stage of uterine cancer causes bleeding?
Bleeding can happen at any stage of uterine cancer. If you notice any unusual spotting or bleeding, see your doctor or get medical help.
Many times, it's hard to know why you're bleeding but your doctor can help you figure it out.